A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/69304
EXPERT COMMENTARY MAJOR FINDINGS This article can be read in light of recent data from the article published in the New England Journal of Medicine by Schauer et al, which reports a T2DM improvement rate of 40% in study participants (this study is also summarized in this compendium). The study by Gill et al quotes a resolution rate of 66.2%. This and other research published on bariatric surgery and its effect on T2DM leaves no question that bariatric surgery and any weight loss is consistently helpful in improving T2DM in patients. LIMITATIONS This paper is a confirmatory analysis that reported 26 studies where patients (66.2%) experienced improvement of T2DM, but only 11 cases reported hemoglobin A1c (HbA1C) levels. It is challenge to understand that such a high percentage of patients experienced T2DM resolution without all studies reporting baseline and postoperative HbA1c levels, as this test truly reflects blood glucose levels. Since this is a systematic review, there is not a lot of control. For instance, there is no information as to whether the patients included had been treated for T2DM with medical management prior to undergoing bariatric surgery. Also, there is no information as to whether or not patients had lost weight prior to undergoing the LSG procedure, which can improve T2DM. WHY IS THIS STUDY IMPORTANT TO THE FIELD? This study is interesting as it is a systematic review of patients who experienced improvement of T2DM after undergoing LSG; however, it contains only six controlled studies and mean follow up is limited to 13 months ± 8.1 months. There is a need to conduct more studies with control groups that have more long- term follow up (at least five years). We also need to conduct more studies comparing sleeve gastrectomy to other bariatric procedures (i.e., gastric band, Roux- en-Y gastric bypass) and their effects on T2DM resolution. I think any interventionally driven weight loss (e.g., dietary restriction, physical activity) is good for the improving T2DM. The more weight loss a patient has, the better for his or her T2DM. However, you will run into patients who fail to manage obesity and T2DM through these methods due to gastrointestinal hormone (e.g., incretin) and beta cell function. In these cases, there is further evidence that bariatric surgery, including the LSG procedure, improves function. Surgeons can use this study as it gives a nice point of consistency on the outcomes of LSG and its effect on T2DM. WHAT SHOULD YOU DO WITH THESE DATA AND THESE FINDINGS? Surgeons can use this study as a nice point of consistency on the outcomes of LSG and its effect on T2DM. SAYEED IKRAMUDDIN, MD, FACS University of Minnesota, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota June 2012 • Supplement • Bariatric Times 13S